Beazer Settles Mortgage Fraud Charges

Atlanta-based Beazer Homes USA Inc. has agreed to pay up to $53 million to the government and homeowners to settle mortgage fraud allegations, reported Bloomberg.com, citing the Justice Department.

It seems Beazer’s mortgage unit inappropriately had buyers pay discount points and did not reduce interest rates when processing federally insured loans, said the Justice Department, according to Bloomberg.com. The Justice Department also stated that Beazer allegedly gave cash gifts to potential homebuyers that were funneled through charities and which better enabled those buyers to meet down payment requirements while also neglecting income requirements, reported Bloomberg.com. (more…)

Warning on Fraudulent Swine Flu Cures

The U.S. Food and Drug Administration (FDA) has released a warning to the public about bogus flu products that are targeting consumers via Websites and other promotional devices. The FDA and the Federal Trade Commission (FTC) issued the alert to consumers to be wary of Internet sites and other promotions for products that claim to diagnose, prevent, mitigate, treat or cure the 2009 H1N1 influenza virus (swine flu). Both agencies also advise operators of such Websites to take prompt action to correct and/or remove promotions of these fraudulent products or face enforcement action.

“Consumers who purchase products to treat the novel 2009 H1N1 virus that are not approved, cleared or authorized by the FDA for the treatment or prevention of influenza risk their health and the health of their families,” said Michael Chappell, acting FDA Associate Commissioner for Regulatory Affairs. “In conjunction with the Federal Trade Commission, the FDA has developed an aggressive strategy to identify, investigate, and take regulatory or criminal action against individuals or businesses that wrongfully promote purported 2009 H1N1 influenza products in an attempt to take advantage of the current flu public health emergency.” (more…)

AMA Sues Aetna, CIGNA Over Out-of-Network Care

Aetna and CIGNA have been named in a lawsuit filed by the American Medical Association (AMA) over health insurance reimbursement payments.  According to the AMA, the lawsuit charges that Aetna and CIGNA used a flawed database to pay physicians artificially low rates for out-of-network care.

The database in question is operated by Ingenix Corp., a wholly-owned subsidiary of UnitedHealth Group.  The database used “usual and customary” rates  to calculate reimbursements for out-of-network care.  The AMA lawsuit seeks damages for physicians from each company commensurate with what doctors would have been paid if the out-of-network pay rates had been calculated accurately. Damages are also being sought for patients who overpaid, the AMA said. (more…)

Cigna, Wellpoint Settle with Cuomo Over Reimbursements

Wellpoint and Cigna, two of the country’s largest insurers, have as agreed to stop using the much-maligned Ingenix database for determining reimbursements for customers who seek out-of-network care.  Wellpoint and Cigna are just the latest insurers to reach an agreement with New York Attorney General over Ingenix.

The Ingenix database, owned by UnitedHealth Group, is used by many insurers to  determine their “usual and customary” rates for out-of-network care.  Last year, the New York Attorney General’s office began an investigation into allegations the Ingenix database intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures, and the lack of audits. (more…)

Independent Health, HealthNow New York Latest Insurers to Swear Off Ingenix Database

Two Buffalo, New York insurers have reached an agreement with the state’s Attorney General to stop using Ingenix, the reimbursement database owned by UnitedHealth Group.   Independent Health and HealthNow New York Inc. are just the latest insurers to agree to end their use of a database the Attorney General’s called “a defective system” to calculate reimbursement rates for patients who go out-of-network.

Independent Health, HealthNow, and many other insurers have used the th United-owned Ingenix database to determine their “usual and customary” rates for out-of-network care.  The Ingenix database uses the insurers’ billing information to calculate “usual and customary” rates for individual claims by assessing how much the same, or similar, medical services would typically cost, generally taking into account the type of service and geographical location.  Under this system, insurers control reimbursement rates that are supposed to fairly reflect the market. (more…)

Cigna and Aetna Named in Ingenix Reimbursement Lawsuit

Cigna and Aetna  are the latest insurers to be hit with a lawsuit over the Ingenix database, which is used by many large health insurers to determine reimbursement rates.  The lawsuits, filed by the American Medical Association (AMA) and several state associations, claims that the Ingenix database was rigged to underpay doctors on out-of-network claims for more than a decade.

Ingenix is a subsidiary of UnitedHealth Group.  The Ingenix database uses the insurers’ billing information to calculate “usual and customary” rates for individual claims by assessing how much the same, or similar, medical services would typically cost, generally taking into account the type of service and geographical location.  Under this system, insurers control reimbursement rates that are supposed to fairly reflect the market. (more…)

Banco Santander Sued

Banco Santander is in the middle of a class action lawsuit over the growing Madoff scandal in which investors were swindled out of millions of dollars.  Bloomberg News is reporting that the lawsuit alleges that Banco Santander and others did not conduct sufficient due diligence to prevent losses in funds that invested money with Madoff.  Banco Santander SA is Spain’s largest bank.

Bernard Madoff’s Ponzi scheme has claimed victims worldwide and, now, investors in Spain are taking steps to recoup their money.  In addition to the class-action suit, over 100 Spanish investors are scheduled for talks with both Barclays Bank and Banco Santander, said the Times Online yesterday, in a bid to recover cash.  Fifty other investors are also involved in another action there. (more…)

Coca Cola Faces Lawsuit Over Vitamin Water Claims

Coca-Cola Company is being sued over false claims about some of its beverages in the second such scandal over its deceptive marketing practices.  Reuters just reported that The Center for Science in the Public Interest (CPSI) is suing the soft drink giant in a class action lawsuit that accuses it of making false claims about its Vitaminwater drinks.

This week’s lawsuit follows an earlier warning by the U.S. Food and Drug Administration (FDA) about its marketing of Diet Coke Plus, said Reuters.  Late last month, Reuters reported that Coca-Cola made claims that Diet Coke Plus includes vitamins and minerals.  Those claims violate U.S. policy against marketing soda and other snack foods as more nutritious, or “fortified.” (more…)

UnitedHealth Settles Class Action Lawsuit with Doctor Group

UnitedHealth Group has settled a class action lawsuit over its Ingenix database.  The $400 million settlement with the American Medical Association (AMA) comes just days after UnitedHealth settled similar charges with the state of New York for $50 million.

United and the largest health insurers in the country rely on a database operated by  Ingenix  -a wholly-owned subsidiary of UnitedHealth - to determine their “usual and customary” rate.  The Ingenix database uses the insurers’ billing information to calculate “usual and customary” rates for individual claims by assessing how much the same, or similar, medical services would typically cost, generally taking into account the type of service an (more…)

UnitedHealth Group to Pay $50 Million to Settle Claims it Over Charged Millions

UnitedHealth Group has agreed to pay $50 million to settle charges that it overcharged millions of customers.  As part of the settlement with the New York State Attorney General’s Office, UnitedHealth Group will also revise the process that health insurers across the country use to determine reimbursements when members receive services from out-of-network providers.

According to the Attorney General’s office, the settlement stems from an  industry-wide investigation begun last February into allegations that health insurers unfairly saddle consumers with too much of the cost of out-of-network health care.  According to a press release issued by the office, seventy percent of insured working Americans pay higher premiums for insurance plans that allow them to use out-of-network doctors.  In exchange, insurers often promise to cover up to eighty percent of the “usual and customary” rate of the out-of-network expenses, and consumers are responsible for paying the balance of the bill. (more…)

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